Following the recent screening of “Freedom for Birth” a film documentary discussing the plight of maternity services and midwifery world-wide I have put together an Action Plan of ideas that you may like to consider to support the midwives and maternity services. Please do as much as you can to make things better for women today and our daughters in the future.

On Thursday 20th September women (and men) around the world will be hosting film screenings to raise the profile of midwifery. I am joining this event because I passionately believe that women are entitled to better maternity care.

Everyone in the UK knows that our maternity services are in crisis and indeed the Royal College of Midwives has strongly stated this.

I am planning to take a break from midwifery as I am totally burnt out … this is partly the demands of being on-call 24/7 for the past 8 years, but it is also due to the increasing scrutiny, red tape and pressures on midwives. I believe that most midwives do their very best for women. Of course there are some rouge practitioners and the public needs to be protected against them, but the pressures on midwives are immense; more paperwork, more investigations of our practice, pressures of working with a system that is barely fit for purpose ….

At the same time Independent Midwifery, which gives “gold standard” care is set to become illegal unless an eleventh hour solution can be found to provide us with Professional Indemnity Insurance which will become mandatory from October 2013.

What will happen to these highly skilled midwives and the clients they currently care for? I’m afraid that I feel ground down and beaten by all that is currently happening in midwifery … it is so sad, midwifery and childbirth has been my passion and my life for the past 20 years!

So, as my swan song to midwifery (for now at least) I am hosting this film showing in Milton Keynes and I hope this will serve to raise the profile of midwifery and to mobilise women to demand the service they deserve.

FREEDOM FOR BIRTH FILM SCREENING Thursday 20th September 2012 Two showings, 1pm and 7pm

FREEDOM FOR BIRTH – GLOBAL FILM LAUNCHA new documentary that reframes childbirth as the most pressing global Human Rights issue today is launching with hundreds of premieres all over the world on the same day, Thursday 20th September 2012.

Freedom For Birth is a 60 minute campaigning documentary featuring a Who’s Who of leading birth experts and international Human Rights lawyers all calling for radical change to the world’s maternity systems.

Hermine Hayes-Klein, US lawyer and organiser of the recent Human Rights in Childbirth Conference at the Hague, the Netherlands says, “the way that childbirth is being managed in many countries around the world is deeply problematic. Millions of pregnant women are pushed into hospitals, pushed onto their back and cut open. They are subject to unnecessary pharmaceutical and surgical interventions that their care providers openly admit to imposing on them for reasons of finance and convenience. Women around the world are waking up to the fact that childbirth doesn’t have to be like this and it shouldn’t. Disrespect and abuse are not the necessary price of safety”.

Made by British filmmakers Toni Harman and Alex Wakeford, Freedom For Birth film tells the story of an Hungarian midwife Agnes Gereb who has been jailed for supporting women giving birth at home. One of the home birth mothers supported by Ms Gereb decided to take a stand.

When pregnant with her second child, Anna Ternovsky took her country to the European Court of Human Rights and won a landmark case that has major implications for childbirth around the world.

Toni Harman, one of the filmmakers says, “the Ternovsky vs Hungary ruling at the European Court of Human Rights in 2010 means that now in Europe, every birthing woman has the legal right to decide where and how she gives birth. And across the world, it means that if a woman feels like her Human Rights are being violated because her birth choices are not being fully supported, she could use the power of the law to protect those rights. With the release of “Freedom For Birth”, we hope millions of women become aware of their legal rights and so our film has the potential to spark a revolution in maternity care across the world. In fact, we are calling this the Mothers’ Revolution.”

Cathy Warwick, Chief Executive of the Royal College of Midwives (RCM), says: “A safe childbirth should be a fundamental human right for women. Sadly, for many, many millions of women and their babies across the world this is not the case. The world is desperately short of the people who can help to ensure and deliver this human right; midwives. There is a real need for leaders of nations to invest in midwifery care in their countries. I hope that the making of this film which the RCM is supporting with a screening will go a long way to help make skilled maternity care a reality for those women who currently do not have access to it.”

Lesley Page, President of the Royal College of Midwives adds, “Too many women across the world are dying or suffering terribly because of a lack of skilled maternity care. This is unacceptable and I call on all Governments across the world to give women the right and access to safe care in pregnancy and childbirth.”

Ms. Hayes-Klein concludes, “Freedom For Birth” holds the answer to changing the system. Birth will change when women realise they have a right to meaningful support for childbirth and claim that right. Birth will change when women stand up against the abuses that are currently suffered in such high numbers and say, No More.”

Freedom For Birth is Harman and Wakeford’s third documentary film about birth. They were inspired to make films about following their own difficult birth of their daughter four years ago. A cascade of interventions in their birth led to an emergency caesarean section.

Very sadly it looks fairly certain that Independent Midwifery will end in October 2013. The Government and Nursing and Midwifery Council have for a long time been recommending that Independent Midwives should have professional indemnity insurance (negligence insurance) despite it not being commercially available in the marketplace i.e. insurers do not provide this insurance for midwives. You can read more about the current situation here http://www.independentmidwives.org.uk/?node=11615

An E.U. Directive is now due to come into force to implement this change and our current information is that it will be illegal for us to practice without professional indemnity insurance from October 2013. This means that women will be denied the choice of choosing an Independent Midwife and we will be denied the choice of working independently and will be forced to stop practising or to return into the NHS.

The Independent Midwives UK organisation has been working tirelessly for years to find a solution and it is just possible that an eleventh hour solution will be found but this is now looking unlikely.

A group of midwives have formed an organisation called Neighbourhood Midwives www.neighbourhoodmidwives.org.uk/ and are working towards setting up an employee-owned social enterprise organization, to provide an NHS commissioned caseload midwifery homebirth service, based in the local community. This may prove to be a workable alternative to Independent Midwifery but at present (if it comes to fruition) the service will only be able to accept “low-risk” women and this is of concern to all of us who have supported women with more complex situations, for example first time mothers, vaginal birth after a previous caesarean, twins, breech birth and women who are not deemed “low risk”. The aim of Neighbourhood Midwives will be to extend their remit to include more women as soon as possible.

There is already a precedent for this type of care as One to One Midwives in Liverpool www.onetoonemidwives.org have already managed to set up a caseloading midwifery service (similar to independent midwifery in that a woman will care for a caseload of women throughout the whole of the pregnancy, birth and postnatal period) within the NHS.

It is a very sad time for midwifery and for women’s choice, but perhaps good things will come out of it, I certainly hope so.

SOCIAL ENTERPRISE PROVIDES THE ANSWER
IM UK reads with interest the mixed reactions to news of a contract between private midwifery provider One to One (Northwest) Ltd and NHS Wirral. The service offered is one the NHS can rarely deliver: continuity of care from a midwife the woman knows, through pregnancy, birth and postnatally. However, concerns have been expressed about the impact of profit-driven private providers on the NHS.

“IM UK believes that the answer lies in social enterprise midwifery: continuity of care delivered by an organisation run by midwives and service users for the benefit of the local community,” states Annie Francis of IM UK.

“That is why we are establishing a social enterprise, named Neighbourhood Midwives, to offer local, community based midwifery services. Care will be free at the point of access for women but provided by a social enterprise, whose values and culture are firmly rooted in a social mission and purpose. We are well down the path and are ready to provide services from April 2012.

“We are keen to be fully integrated into the whole maternity care pathway, ideally through the planned networks currently being discussed. We will be able to offer care to women planning a homebirth but often unable to access this choice because of current shortages of midwives within the NHS.”

Historically, insurance issues have been a barrier for not-for-profit providers. During recent debates on the Health and Social Care Bill, Baroness Julia Cumberledge emphasised the need for social enterprise organisations such as Neighbourhood Midwives to be able to access insurance via the NHS Litigation Authority (NHSLA).
For further information contact:
Annie Francis
07977695948annie.francis@independentmidwives.org.uk

Where to start? Every day is different, so I’m going to give you a flavour of the sort of things I get up to.

Of course I have antenatal appointments; from the first tentative telephone enquiry I then arrange to meet up with a potential client (usually for an hour or so) so that we can discuss their past experiences, their hopes for this pregnancy, their concerns and most importantly so that they can get a “feel” as to whether they actually like and trust me. Once a couple have decided to book me as their midwife I then usually give all their antenatal care in their own home (although I have done antenatal visits in The Bank of England medical room!). The format of visits is that I carry out all the usual blood tests, urine and blood pressure checks, but also leave a lot of time for discussion so that over the course of the pregnancy we cover issues such as waterbirth, Vitamin K, when to call me and so on.

My clients come from a wide area – I am happy to take clients who live within approximately an hour’s radius of my home in Leighton Buzzard – so I do spend a fair bit of time driving, as well as liaising with G.P.’s and hospitals where necessary.

Four times a year I jointly organise an Antenatal Exhibition, this is an opportunity for pregnant couples to gather information about breastfeeding, pregnancy yoga, cloth nappies and the like. We also organise Birth Preparation Workshops and am often to be found at the Community Desk in Central Milton Keynes on hand to speak to expectant parents and also regularly attend Study Day’s and midwifery meetings to ensure that I keep myself up-to-date with current research.

Obviously I spend much of my time being “on-call” for births. My own family are now pretty much grown-up and the commitment isn’t as big as one might imagine as I rarely have more than two births during a month – it is important that I don’t over-commit myself as the whole point of what I do is that I guarantee to be there for the birth. Babies don’t always read the text books though! I have had three births in one week, as of course some babies do come early and some come late! As you will appreciate, the birth is the big event, and it can on occasion go on for some time.

Baby being here doesn’t mean that my job ends! In fact, postnatal visiting is often one of the busiest times as the family may need quite a lot of support in the early days. The majority of my clients choose to give birth at home; however some either need to, or choose to give birth in hospital.

I visit my clients for up to four weeks postnatally and it is a joy to see the baby thriving and although discharging clients is always tinged with sadness it is also great to know that I have played a part in helping the family on to the next stage of their life. (I do usually keep in touch, perhaps not as often as I would like, but I often get e-mails and photographs and usually pop in when I’m passing!).

So, in summary I guess the main differences between me and an NHS midwife are that you are buying my time; antenatal visits usually take around an hour and a half (instead of perhaps 10 – 15 minutes at your local surgery), are arranged more frequently and take place at a time and place to suit you. Most importantly you will receive full continuity of care – I will see you at each visit to build our relationship and plan your care and you will know that (barring exceptional circumstances) I will be with you in labour and available 24/7 for urgent help.

I am always happy to discuss anything that you are concerned about; please do feel free to call.

No two pregnancies are the same, so it is very important that you continue to look after yourself by eating and resting as much as you possibly can. Remember this time you are also looking after your little one(s) too. You may feel better or more tired this time around; and certainly having a toddler is hard work. If your toddler sleeps then you should rest and not rush around doing housework! If you are exhausted try asking a friend if they would have your toddler for a couple of hours so you can rest. I can’t stress enough that you need to eat a good diet – ensure that you eat plenty of protein and iron rich foods.

You may notice that you “show” earlier second time around, this is because your tummy muscles have been stretched before and is quite normal. You may also notice baby movements a little earlier because you know what you are looking for, but don’t worry if you don’t!

Some women say that they are anxious about labour second time around; if you had a difficult labour talk to your midwife about it – ask her what happened and why it happened and what are the chances of it happening again, however second births are usually much easier and shorter. It is usual to be a bit anxious about labour – most women are, but remember you did it last time and you can do it again!

I think it is definitely worth attending childbirth classes if you can – I had four children and I went to classes each time – it gives you time to concentrate on this pregnancy and this new baby; and a birth plan is a great idea, second time around you are better prepared as you know what to expect, you know what you want and don’t want to happen so put it down into a birth plan and if you need advice speak to your midwife.

Successive reports have called for one-to-one care in labour as all outcomes are improved, for example women are more likely to have a normal birth if they receive one-to-one care. However, to some women this means having the same midwife from booking, through the antenatal period, labour and birth and until postnatal discharge – this type of care may not be available in your area unless you employ an Independent Midwife www.independentmidwives.org.uk.

Consider having your baby at home, there are so many benefits, women usually have shorter and easier labours and this time you will be better able to read your body and can stay at home if you feel comfortable and relaxed and you won’t have to leave your first child whilst you are in hospital. Staying upright and active will help with the contractions and also keep the baby in the best possible position for birth, but your body will tell you what you need to do; try to relax and have faith in the birthing process.

Women generally recover quicker second time around, this is partly because labour is usually quicker and easier – and also because being an experienced mother usually helps to establish feeding more quickly.

Unfortunately, the more babies you have, the stronger the after pains usually are – this is because your uterus is having to work harder to contract. Ask for paracetamol which will help and is perfectly safe to take.

Remember that your other child(ren) will need extra love and reassurance – your new baby is much tougher than you think, try to involve the older sibling(s) in what you are doing and have patience – it is usual for children to regress a bit when they have a new baby in the house. Accept any help that is offered and consider staying in your pyjamas for a few days – it shows that you are not at full strength. I think women try too hard to be superwoman, just allow yourself some time to enjoy your new baby – they aren’t babies for long, although it sometimes feels like it when you are in the thick of it!